CMS Price Transparency Data

Physical therapy (gait training)

Facility: Saint Agnes Medical Center

Billing Code: 97116 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97116
Insurance Median: $94
Cash Discount Price: $105
vs. Medicare Baseline: 3.23x Medicare

The contracted insurance negotiated median rate for a Physical therapy (gait training) at Saint Agnes Medical Center is $94. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $105. Compared to the federal Medicare reimbursement reference rate of $29.06, this hospital’s rate is 3.23x the Medicare baseline. Located in 1303 E Herndon Ave, Fresno, CA.

Cash / Self-Pay

$105

Average discount available for prompt cash payment at this facility.

Insurance Median

$94

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$29.06

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $29.06 (100%)

Cash / Self-Pay: $105 (361%)

Insurance Median: $94 (323%)

Cash: $105 (361% of Medicare)

Ins. Median: $94 (323% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $29.06 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 323% of the Medicare baseline (a markup of 223%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Correctcare Integrated Health	$20	69%
Medi-Cal Healthnet	$21 - $24	72%
Blue Cross Blue Shield	$23 - $358	79%
Aetna	$30 - $94	103%
Humana	$30 - $32	103%
Medicare (plans)	$30 - $32	103%
UnitedHealthcare	$31 - $566	107%
Welbe Health	$32	110%
Align Senior Care	$35	120%
Kaiser Permanente	$54	186%
Blue Shield - Ca	$66 - $358	227%
Advantek Central Usd	$69	237%
Meritain	$89	306%
Trustmark Small Business Benefits	$89	306%
Allied Benefit Systems	$94	323%
Boon Chapman	$94	323%
Hap	$94	323%
Webtpa	$94	323%
St Agnes Nicu Valley Childrens Hospital	$105	361%
Healthnet	$110 - $132	379%
Coventry	$111	382%
Cba Network By Design	$122	420%
Network Health	$122	420%
Allegiance	$125	430%
American Postal Workers Secondary	$125	430%
Cigna	$125	430%
Multiplan	$136	468%
Phcs	$136	468%
Interplan	$146	502%
Blue Benefit Administrators Of Massachusetts	$358	1232%
Blue Care Network	$358	1232%
Blue Distinction Transplant	$358	1232%
Blue Shield - Id (Regence)	$358	1232%
Blue Shield - Ny Highmark Northeastern	$358	1232%
Blue Shield - Ny Highmark Western	$358	1232%
Blue Shield - Pa (Highmark)	$358	1232%
Blue Shield - Wa (Regence)	$358	1232%
Geha	$558	1920%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $105.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97116.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Saint Agnes Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97116.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.